Patient safety

WHO Surgical Safety Checklist Implementation

As with any new tool, one of the biggest challenges of the WHO Surgical Safety Checklist is to ensure its successful implementation. WHO thus launched an implementation manual alongside the Checklist to aid its introduction.

Download the Implementation Manual here:

As use of the Checklist has become more widespread, specific implementation factors have become more apparent. Factors for successful implementation include:

  • Early engagement of staff
  • Active leadership and identification of local champions
  • Extensive discussion, education and training
  • Multidisciplinary involvement
  • Coaching
  • Ongoing feedback
  • Local adaptation

Modifying the Checklist for implementation

To ensure successful implementation, it is important to make sure that the Checklist is suitable for your setting. Adaptation after local consultation is encouraged.

Checklist Adaptation Guide

The WHO Surgical Safety Checklist can be reproduced in its entirety without any modifications or adaptations to layout or wording. This includes the WHO emblem as it appears as an integral part of this tool.

If the Checklist is modified in any way, the WHO logo should not be used. Instead, in order to acknowledge the original WHO source, the Checklist should bear the following text:
“Based on the WHO Surgical Safety Checklist,, © World Health Organization 2009. All rights reserved.”

How do I know whether the Checklist we already use meets the goals of the WHO Surgical Safety Checklist?

Conduct a small test. Print out the WHO Checklist, use it for a case, and note the following:

  • Does the entire team stop all other activity for a few moments at three critical points, i.e., pre-anesthesia, pre-incision and before the patient leaves the OR? The goal is for the entire team to participate in each pause. (The surgeon may not have to be present for the pre-anesthesia check.)
  • Does the entire team verbally confirm each item on the WHO Checklist? The goal is for the entire team to participate. At a minimum, every item on the WHO Checklist should be confirmed. Other items may also be addressed.
  • Are the items verified without reliance on memory? The goal is to use a tool for reference to ensure every item is covered, e.g., a form, poster, or computer screen.

If you can answer “yes” to all of these questions, then the spirit of the WHO Checklist is being met. Consider running through this exercise with several more cases to see if this occurs with every patient every time. If not, redesign your processes to ensure it does.

Improving teamwork and communication is one of the main goals of using a checklist. Many hospitals are already doing most of the items on the list but not reviewing them as a team. If there is no designated point when these items are reviewed, it is common to find that they are verified most of the time, but not every time, i.e., not consistently. The results of the WHO pilot study appear to confirm the conclusions of a number of earlier studies that indicate that preoperative team introductions and briefings and postoperative debriefings contribute to improved processes and outcomes.